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389 ESSEX STREET - BUILDING JACKET ,s �9 t=�SS�k �� CITY OF SALEM a PUBLIC PROPERTY ' DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON$1REEI♦SALEK y MA.SSACHUSErCS 01970 TEL 978-745-9595♦FAx:978-740-9846 COpy August 29, 2007 RE: Allowable use regarding 387 Essex Street Dear Property Owner; I have been asked to comment on the status of 387 Essex Street. The Building consists of a first floor apartment with a Medical Office attached. The Upper floors contain two additional residential units. The Doctor's Office is grandfathered for that use specifically. If the use is abandoned the first floor will return to a residential use automatically. The Primary use of the Building is residential. Sin ly, 7 Thomas J. St. Pierre Director of Inspectional Services/Zoning Enforcement Officer Building Commissioner CC: file . r. _. ^� : .y,;....^ f ,.+^w..,:,. 'a^ ,...w..'�....A•.....r,..e+,...r .�.r-v�'.yl,.ti_. �« _ �.. k .9.. :-s. r .,1, 'y'^-:s'.w,.w: ' � ..-a^"'y FIELD.COPY CITY Of SALEM BUILDING SALEM. MASSACHUSETTS 0100 PERMIT 4E� GATE fan. 12, B 93 8-93 'I E 'LLA 677.^' PERMIT NO._ 554 APPLICANT Bertrand I(e�eune ADDRESS Tro,�C. Iu0.1 IS1RE(il ICOu R' IiI�CS ufl "Y RE�IMTICNS NUMBER OF PERMIT TJ 1 N 31 STORY DWELL ING UNITS RRjjOVCMC�MqiI n0p I'PR OROf[C! USCI -� ♦T )LOCATION) M ✓8 Ess, `~ V a ZONING DISTRICT I u0.1 IfTREC BETWE_'. - - CROS. ST.Ef TI (CROSS STREET) SUBDIVISION LOT BLOCK LOT SIZE BUILDING IS 50 BE 1, W, PI FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE U ROUP BASEMENT wgLLS OR F UHDA ION Provide 2nd. egress for third floor apt., renovate free t R REMARKS: convert tut. & 2nd. floors Into one apt. each CATS. FOR PERMIT 10 OCCUPY 7 -y JS AREA OR p 48,000.00 PERMIT 293.00 VOLUME ESTIMATED COST S Steve Sass 1CVEIf SOUARE EE[11 FEE OWNER Steve ss ' AnDRE55 y Crossman Ave., bwI:pFla Leo E. Tremblay INSPECTOR OF BUILDINGS INSPECTION RECORD PATE NOTE PNOONEU - CRITICISM$ AND REMARKS INSPECTOR +j3-26-1999 4:48PM FROM P. 1 V. , City of Salem, Massachusetts }ire Department 48 4afayette Street Vert'W Turner Sskm+Mnss=6wetts 01970.3695 Chief7c1.978-744-1235 `ire Prevention Bureau 978-744-6990 FaX 978-745-4646 978-745-7777 March 26, 1999 Mr. Steven Sass & Ellen Golub/Sass 16 Ida Road RE: 389 Essex Street] Salem, Ma _ Marblehead, Ma. 01945 01970 _ - - - Dear Mr. & Mrs. Sass: On the above date Myself, Assistant Building Inspector Kevin Goggin, along with your wife Ellen, inspected the property at 389 Essex Street as a follow-up of a letter I received dated February 27, 1999, from Ms. Donna Henderson a tenant. As the result of the inspection the Building Depart- ment and Myself are in complete agreement that the property is up to code and in full compliance for fire preventive measures. Mr. Goggin advised your wife on a couple minor improvements to make in the cellar area, and I know they will be taken care of as soon as possible. Thank you Ellen for your co-operation during this inspection. Respec�tl�iifullly4Sufitted Frffink ��~ Fire Inspector CC: Chief Robert Turner Salem Fire Department Building Department Ms. Donna Henderson P1 must must be filed and approved by the inspector before a permit for erection will be g �r duplicates of which when approved by the inspector shall be kept at the buddhsg, during the progress of the work. City of Salem N W • - -2 TEL.# 5 STATE LIC. f 0 /?� 7 73 APPLICATION CITY OF SALEM LIC.i s3 FOR PERMIT TO BUILD ADDITION OR MAKE ALTERATION'S Salem.Melo. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a Permit to build according to the following specifications: Owner's name and address Architect's name P�KQ,v ere. Meebanie's name and adder Location of building. No. What is the purpose of building? Material of building? U a dwelling, for how 'many families? Sin of Addition: No. of feet front. ; No. of feet rear,—; No. of feet deep No. of stories? No. of feet from the level of the ground to the highest put of the roof? How near line of the street? How near line of the adjoining loft What will be the moans of accost to the real- She of floor timbers. lgt� . finder—; Sid Span. Distance on tented? Size of carrying timbers- Distance of supports on centers? What kind of support? Will the building be erected on solid or filled land? i What is the material of foundation— Will the roof be Qat. pitched. mansard or gambrel! 1 Material of roof covering? Will the building be heated by steam or hot water or hot girt No. of brick walbt When Ionated? ThWmen- Will the building coolant to the requirements of the IawL--1 Estimated cost Signature of applicant REMARKS PE; -%L y OF FEI UNDEJRY r/0 0,A) APPLICATION FOR PERMIT TO BUILD ADDITION OR MAKE ALIERA710NS Locatia PERMIT GRANTED . l/ 19 B.Ud=r Smoker U I I Flo k z APPROVED Snbret to app val by any/0th: ;u"l,^,-.•i`.y having jurisdiction. 'ALEM,MASS. FIRE" t VENTION B BY PLPPU"ti APPRO 0 LELY FOR 10ENTIVICATION OF TYPE A"10 LOCATI ' OF FIRE pROTECTJON DEVICES. ALL FIRE PRO7E loll DEVICE&ARE SV OIECT TO A FINALT�5"f ANO IP; VECTION,FOR COMPLETE COMPLI- ANCE"9TH THE'IRE CODE. �.. _.� �� �� �� U �`� � Y �' �� � ��;�� �, � 3�9 ess�` _. �� U m - - ,� �� �� 7 0� 3 �,� Q Ss�� �� �� �anr�na��uue�a� o��;�aaaa�ivaella f J ni �$rsuai„o o.n not, Jtarraaaaas �tichaei S. Du"s ,�IILIO,o, -AM& 4'. J Govemor one ..LY.f�af Ozy,. - Raam x.10/ 02108 Kentaro Tsutsums Gtkuco+�. lfaooaviab 6171 Chairman T_ •3:D0 Charles j. Dino Admtbdtntor ME %10RAND U %4 TO: All Building DcpartmcnssrSutc budding Inspectors FROM: Charles J. Dineuo. Administrator DATE: October 31. 1988 $UMEC1. MGI. ca0 ti54 Addrd Rr rSM, ti9 n! the nm of 1987 lting ram lfilkligsk oThe r other of a bull di g or structure be disposed ufOf ntaeproperflvt licensed scold waste bdltpoaat or othiltv s deGnm by MGL clll. S1S0A and that budding permits or licenses are to Indicate the loanon of the faahty at which the said debns is to be disposed. THIS REQUIREMENT DOFS NOT APPLY TO NEW CONSTRUC'TON. In order to simph(v the proms and to prtrvtde undormitv, we are attaching a copy of a form which Y= can either reproduco and use as it is since the completed form will be atuched to the otftcc copy 8 permits or It=== or reproduce it on your letterhead- in cue of municipal.commercial.industrial.or multi•undt housing construction.the contractor may not kaon the dumrter subcontractor at the time of the building permit application. In such aus• the loaded w" of an Affld2vit call be used. The complete jaw i you contained in the should have am v aft oIssue n, please of cot us nRO which will be marled to You in ties two CMAM C! ' (zity of geairm, 4+lassartusEtts Y ro > r{ public Draprrtp Deaartmrnt Suiibinq -Department ent x2sum ektrn 735-a595 Czt. 320 William H. Munroe Director of Public Property Inspector of Buildings Zorung Enforcement Officer In a®mance "in the provutam of MGL c 40. S 54. a mnotuon of Building Permit Number is that the aebrts resulting from lhts warK shall be dabosw of to a property uccnsea solid waste dup=l factury as defined by MGL c 111. S 150A- 7Le cans will be disposed of in: (laduan Fauuryl �-y���� 17 Signature of Permit npptita Date P_' c COMMONWEALTH OF MASSACHUSETTS Elk DEPAR:'MENT OF INDUSTRIAL ACCIDENTS _ 600 WASHINGTON STREET Janes„ Carnooec BOSTON, MASSACHUSETTS 02111 �o -m!sslone, WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licenser/perminee) with a principal) place off business/residence at: (C istatcizip do hereby certify, under the pains and penalties of perjury that: V"I"am an employer providing the following workers' compensation coverage for my employees working on this job. 2 - 5 /— 6 - 9e2 - o Insurance Company Policy Number [ ] I am a sole proprietor and have no one working for me. ( ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number [] I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sea. 13)),application by a homeowner for a license or permit r:y evidence the legal status of an employer under the Workers' Compensation Art I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to $1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of$100.00 a day against me. Signed this l day of Il ttil 1. 19 1 3 Licensee/Permittee Licensor/Permittor ........ .. APPOINTMENT FOR FINAL Salem Fite DepaAtinent Ftte P-tevent.Zon BureauAPPOINTMENT FOR FINAL INSPECTION MUST BE 48 La4ayette Sttee-t INSPECTION MUST BE MADE AT LEAST ONE WEEK Satem, Ma 01970 MADE AT LEAST ONE WEEK f (508) 745-7777 FIRE DEPARTMENT 'CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In accordance with the p,%ovt-6ton,6 04 the Ma-"acJvu6ett,6 State Buitdtn_q Code and the SaZem Ft4e Code, appttcat.Zon .tis hereby made 6o-% approval o4 plan and the 4-"uanr-e o4 a- ceAtt4tcate 04 approval 4o-% a bu,&Zd4nq pe,%mtt by the -Salem F-Z-te Department. (Re4. Section 113. 3, Mo,6-6. State SZdg. Code) Job Locatton.. Owne-,t/Ocr-upant. Etect4,4cat Contractor: F4.ice` Supp,,Le."Zon Conttar-tor: Signature oj Appt,LczLnt: :Phone Add,t".6 o4 City OL Appt-i.cant: r? Town: a. Approval date: Ceicti4tcate o4 app-tovat r.a hereby granted, on approved ptan,6 on zubmztta 04 project detatt-6, by the Salem F4,te Department. All ptan-6 ane approved .6oZety 4o4 tdentt4tcatZon o4 type and tocatton o4 44re protection devtce-6 and equtpment. Att ptart,6 are .6ubjec-t to approval o4 any other autho4tty having junL4dtct-Lon. Upon completion, the applicant wt tn,6tatte4(.6) .6haU 4eque-6t an t"pect-Zonand/ojL te-4-t o4 the -64,te protect-ton devtc" and equipment. FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE New con.6t-tuctton. Property Zocatton ha4 no compliance with the ptovt-6to" o4 Chapter 148, Section 26 C/E, M.G. L. . -teXa-t'Lve to the tn-dtatatton o4 approved 4.Z4e alarm devtoe4. The owner o,6 tk,4,6 property " requi-ted to obtain compliance a condi t-Lon o4 obtaZaing a ButtdZng Permit. Property ZocctZon 4-6 tn comptZance with the p4ovt4t on,6 oj Chapter 148, Section 26 C/E, M.G. L. ExpZ-Yat.Lon date: 41 - 9 0 a,4 Fee due: under 7 , 500 So. Ft. 10. 00 w. FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In compliance with the provision of Section 113.5 of the Massachusetts State Building Code, and under guidelines agreed upon by the Salem Bldg. Inspector and the Salem Fire Chief, the applicant for a building permit shall obtain the Certificate of Approval (see reverse side) and stamped - plan approval from the Salem Fire Prevention Bureau Said application and approval is required before a building permit may be _J LO issued. The Massachusetts State Building Code requires-compliance , W approval of the Salem Fire Department, with reference to provisions of a W w So Articles 4 and 12 of the Building Code, the Salem Fire Code, MassachusettsW y o General Laws, and 527 Code of Massachusetts Regulations . 1e The applicant shall submit this application with three (3) sets of plans, oz drawn in sufficient clarity, to obtain stamped approval of the Salem Fire in Department. This applies for all new construction,: substantial ` `' ' " o W W alterations, change of use and/or occupancy, and any'other approvals Q- cn required by the Massachusetts General Laws, and the Salem Fire Code " `` "a z 2 a 'r'T- Exception: Plans will not be "required for structural work when the ' . proposed work to be performed under"`the building permit willzX "vA not, in the opinion of the Building Inspe'ctor;-­requirip a �..0 'i plan to show the nature and character of the 'work ' `be performed. f'A S 7 S� 7r h 1 Notice " Plans are normally required for fire suppression systems, s: � s - fire alarm systems, 'tank installations,, and Fire C ode . requirements. Under the provisions of Article 22 of the Massaehusetts'State Building Code, certain proposed projects may not require''submission "of plans or complete compliance with new construction requirements.`, In`the'se cases, Provisions of Article 22, Appendix T,"and' Tables applicable shall apply. This section shall not, however;"supersede the provisions outlined in the Salem Fire Prevention Regulations, Chapter 148, MGL, or 527 Code of Massachusetts Regulations-"OkAll'permi°ts for fire code use and/or occupancy shall apply for`the entre `structure; ` fire alarm and/or smoke detector inatallation 'ahall �apply to the . entire structure based upon current requirements as per°Laws and/or Codes, but the existing structure may comply with regulations applicable for existing structures. Notice: Sub-contractors may also be required to file individual applications for a Fire Department Certificate of Approval for the area of their work. .Such sub-contractors shall file an Application to Install with the Fire Prevention Bureau prior to commencing any work for those areas'"applicable. T FoR F1NPd Form 81X (10/90) TppENT FOR gE AL 1001 T�N MuSONE WEEK SP T APPONTION MUST E WEEK `. 1N EAT 1 EPS 1NE AT EEPST O� M�EpD pN C Ir G) i WO _. CA ,u 1► �La. . ri nl�tlV.Cx�'i^x1�i':TI!'ii.` T ' �:fvb�.•M��l LiM''•"1r, �'-r�i.l.f��'L'�J'Ti+�.i�fif(• F�n'fF1! T)'I.13 ' ,y:�11��i U}.`i".��!! x .� •' 't�k►(1��� !i.Mtll'4�M'd��,�.S,�tVf\t�T'�►�'•l ii47. . .. ... ... . >M+r�►Vl`+r±�t1+NHHw'm �.F. .•.��� ,.i•il=hA(i�, ill '1\l1.\!T`r,t, _I• i .f.. '.��h.': ..�,1. ( !ill .•1" 1• ,.Tt':•� t' ., .�1a fir- ' - � >T�{., t�� .. . W � ,�;\sh•i+..•.•r, pft.tibf 41r'...�' .;•o ft'.: . • I (er>,neKt,:' c•�,ef 4..11U!Lat.(Al ' i t,. :,,,•;t.�.15i: :.,.H.lp: }h; �lr.' ,.v . .,... . ,: ;u'r .chat• \ ttr , i9• !hie'., �..VCr; Ne'.."yH.�M; � �. ;, .. . u, ;Lp:. ;;,,':kc ittri. . :u '•A'J'y'�)P leN /C•: �:� Ny't,,Sf• �?f:,�: • • •J • �.'..:iYb ,. .-'•!It!;...jn."n;:.,. ,�»tiL'ert:`•'';•.tn). • t,r�''TI{'i ::,,�,..' .; a1Gy',tY. pk..,. Via. • -. �.- 1. �--!t¢� ,�,..,a,.,.e�. �tSG;' �Shlh T ,•... 'i• . ::ty��'i;:;f.61�= Yi5!.(.�' ..`.Y; 't '�::ttfSi►�{,►vfi�Wit:`P'4ifY•%Ln.j'.t?i`. • .yY `_I .r!! �':'4t'.1 !E: xiT�: t! r :'� r`It1►�t�l'r:+�.t+ �t� OJI�f•. ' Z ` �. *Air r - . m►>r�: 7 2 � o of a�A�E17I, R���L�JU�E1�� PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BITING GRANTED Budding Permit Applieatior For Loather of Building 3 S� Ems f S T '(Circle whwbc mr tgtpiiea) Roo&Remo f Sidiag,Construct Deck,Shed, Pool Additi9 Altaatio P��P .FongdtlionOnl�'. Wmking PLEASE FILL OUT LEGmLY& COMPLETELY TO AVOID DELAYS IN PROCESSING To the Irugtecttor of Bui►diogt Tbo undyed hereby applies for a permit to build according to the foilowing apecifiatiooc Owrat Nape: I f1 Caatndor.��� meet-e��� FiSSEaG of City Sam �y Snte Phone mf)94•0- —?0 5 L. - State Phone( ) Amblwt: Sever City at stria.Lill , Street City State I State Phone ( ) Howtwoen Exempt Fan ss ya cto Structure: (pleme dtde) Single Family. Multi Family M Estimated Cost of job S Qr� Wig building comnm to lain�,q Deaeriptia dn wodc 16 be dare;'*"`+" Drawirp Suter; ` no m Pe to:L���ZP /VCGOZr'tn' . � SipaWrs of APPYcadors$ GNE UNDER THE ENALTY OF PERJURY CONSTRUCTION TO BKOMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE Dgwtmmt use only: Perm4m—•-,--_ Zorling Farmit fee S COIBlmTS: Le-7 0 5I The Commonwealth of Massachul,9ftC REC IVEg. . o Department of Public Safety ONAL SERVICES (1 Massachusetts State Building Code(780 CMR) `y Building Permit Application for any Building other than a One-orMho elling © is;$ection For:Official Use only) d tom, Building Permit Number: Date Applied. Building Official: i SECTION 1:�LOCATIQN(Please indicate Block#and Lot £or locations for which a street address Is not av 'ladle) No.and Street City/Town c Zip Code fVf�3 Name tf Building(if pplicable) -___ SECTION 2:PROPOSED WORK t Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes )d No ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 Not Brief Description of Proposed Work: , SECTION 3:COMPLETE THCS SECTION IF EJQSTWG BUILDING UNDERGOING RENOVATION,ADDrrION,OR CHANGE IDI USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION BUILDING HEIGHT AD:4 N A&£A Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION Ss USE GROUP(Checkas appliciable) A. Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ R Facto F-1❑ F2❑ I H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1❑ I-2 0 1-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3❑ R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use 0 and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(check as applicable} IA IBO IIA0 IIBO IIIAO IIIBO rv ❑ VA13 VB13 (rfrto78M each SITE INFORMA Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ r Private❑ or indentify Zone: or on site system❑ required 0 or trench or specify- permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes 0 or No❑ Yes❑ No ❑ SECTION 8 CONTENT OF,CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: 0) T21 I LA971D . I,L � (o SECTION 9: PROPERTY OWNER AUTHORELATION - Nanag arxd Address of Pr ope Owner � I IV 389 e #` 3 Sulu, a oia�a Name(Print) 1IIo,and Street City/Town Zip roIlp�erty Owner Contact Information: �VlY1SfinP3cl �o�t Crn llV@ me. wry Title I Telephone No.(business) Telephone No. (cell) e- il address applicable,the pr�hereby authorize r�rJC `q. ✓(a 02.06=(� Name Street Ad ress City/Town State Zip to act on the property owners behalf,in all matters relative tAvork authorized by this buildin permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) f buildin isl6w than 35,000 ci:A.of enclosed s ee and/or not under Cpnstruction Control then check here p and ski --.Section 10.1` 10.1 Re is red Professional Res onsible for Construction Control _p�� (Registrant) -Telepho W e-mail address Registration Numb an4Gf '2 ��CA 1 Llli�l r�. 71 Street AddT4 City/Town State Zip Discipline Expiration Date 10.2 General Contxacfor[� /'' Coy Name r �-) gee Q�S- Name of Person Responsible for Co ction License No. and Type if Applicable w60c) u►cl Wa I/lku m� oases Street Address City/Town State Zip Telephone No.(business) Telephone No. cell I e-mail address SECTION UMORKERS'COMPENSATION INSMANCE AFFIDAVIT(M G.L.c.152:9 25C 6) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a si ed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCRON-COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ it 5o e0 appropriate municipal factor)_$ 3.Plumbing $ GU 4.Mechanical (HVAC) $ Note:Minimum fee=$ /(ccontact municipality) 5.Mechanical (Other) $ Enclose check payable to / y.J r 6.Total Cost $ a . jo (contact municipality)and write check mmnber here SI?On 13:SIGNATU OF`BUILDING PERMIT.APPLICANT By entering my below,I hereby attest der the pains and penalties of perjury that all of the information contained in this appl' afio tru d accuraMthe /my knowledge and undersrtrad�Wing.cc ChJlS � tnf 1 � �I � YttPoW^aL �o a Please print attest n e Title / Telephone No. Date Street Address City/Town State Zip Municipal3nspector to fill dot this section upon application approval: ante Date Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107.The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where plicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm may require re aters 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas(Natural,Propane,Medical or other 10 Surveyed Site Plan(Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other S 22 Other S *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified most not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State Zip Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed t ensure for public safety. P P Y d to p x ty Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block# and Lot# for locations for which a street address is not available) 3ii A- C-'�Zle6' Vyl� 0l9 u No. and Street City /Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Massachusetts - Department of Public Safety Board of. Building Regulations and Standards Construction Superi isor Y License ; CS-085982 A:k- I J KONSTANTINOS, I J S ''; ' 20 Woodville Way ,d Wareham MA 02571 4, 6"' S P tint Ex i ration -� Commissioner 05/15/2015 Generated by CamScanner Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 u �y Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration- 162902 Type: Private Corporation Expiration: 4/17/2015 Tr# 240475 SCITUATE CASEWORKS INC. ----------- ERIK KNAPP — 7 SANGAY LANE SCITUATE, MA 02066 Update Address and return card.Mork reason toy change. I"1 Address i Renewal Employment I_. Lost Card SCF i iS 20h4A5'it 11M A ® R DATE(MWDMYYY V) CERTIFICATE OF LIABILITY INSURANCE R045 10�20/2014 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS -CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATIONIS WANED,subject to the terms and conditions of the policy,certain policles may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT NAME' PRIMECOR INC (AMC.No.EMT (877) 287-1316 iA c`.wap (877) 287-1315 250747 P: (877) 287-1316 F: (877) 287-1315 ADDRESS: PO BOX 33015 INSURER(S)AFFORDINGCWERAGE NAC0 SAN ANTONIO TX 78265 INSURERA: Twin City Fire Ins Co INSURED INSURERS: INSURERC: SCITUATE CASEWORKS INC INSURER D: 7 SANGAY LN INSURERE: SCITUATE MA 02066 INSU REEF : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIGNS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IASR r EOFINWURANC£ ADDL SURR mu xUMIER FDCIC'YEFF P L(C'YEXP LlNlTS MALDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE ❑OCCUR DAMAGETORENTED PREMISES(Ea o nsnce) MED EXP(Any we person) PERSONAL S ADV INJURY GENt AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE POLICY PRO,❑LOC PRODUCTS-GOMPIOPAGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Pets dsrt) AUTOS AUTOS HIREDAUTO NON WNED PROPERTY DAMAGE $ AUTOS (Per.c srft) UMBRELLA LUIB OCCUR EACH OCCURRENCE EXCESS LIAS CLAIMS-MADE AGGREGATE g DE REIENTMa S NORE£RSCDMPEYSARQY X PER OTK 4VO CVPLOYE'/!S'IJAH/L/TY $TARITE ER ANY PROPRIETORIPARTNER,EXECUTIVE YIN E-EACH ACCIDENT 11, 000, 000 OFRC,ERIMEMBER EXCLUDED? A (Mans fw In NH) ❑ wA 76 WEG DR1460 04/27/2014 04/27/2015 E.L.DISEASE-EA EMPLOYEE 1, 000, 000 If yes,describe urMer E.L.DISEASE-POLICY UNIT $I 0 Q Q Q Q DESCRIPTION OF OPERATIONS below T / DESCRIPTION OF OPERATIONS/LOCATIONS/VEHKLES(ACORD 101,AIIfd.W Remarks Sc .Ie,maya aNacNed Nnmrcapace Is rc Ufl ) Those usual to the Insured' s Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Christine Reilly AUTHORREDREPRESENTAnIVE 389 ESSEX ST SALEM, MA 01970 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD printout http://kitchenplanner ikea.com/US/Ul/Pages/Printouts/VPLTISummaryPri... Reilly STO Plan 20140807 - Pla View All measurement in inches ` 0000-6794-4719 \ z 4s ri € vv 144 o isns ka 4 --- - 35 92 33 p \ . m L 2 of 7 8/7/2014 5:07 PM mke PERMIT NO._ Bnb%MAUU#M7- sm' • Pte�e Z t..t i UNW Abeyeass -m@-!Cbq* malp�apetY� LQIaaaoaeai� a aigmataled»adt- = 1}psafp�eet( (ToH�dAorPmt m l.*- tametsidateirgi iorr �0 20 IamambpNO&OWcrpnow t®6edasim r�eaalce6 7. ... - - �ad�5g ibrmoisaas�x - aTptsyesaedLsewaal'a�' -- Q�mo�o� - -- (xovmt�.aamp��sm� b3 I - - 5.�W6deaampoa6�amt�: _ t�T�aep�asa3d6ttms 3.� IaaaS�ie�aYwo�i�- -�oeslxee�miadthsm_= ._11Q �amd�o�ar. �,Ogaetie�- - -i�am�sm�}t•- - a13a,$I(4��damla!meas:- _ tMs l ml III y - wom ra�t eaµloi�aml�. - rr+r..�s._ea�„rli,�a��,.l�s��*giias. - •-. eiep.�siJ�is�- r�sa*sasi�r�s_ �1io. W� wit t4ist}- -c,f � r Ui 47Cj ao�esm8eal�.iedd�spr�eM��atlespistl�a�j, . FaEtuetoae®em sasmgmT�adasdeeSedioe2l�l�u a19Zea1�l��ei®pmii�� I meufw. fmm�toil¢OR09adlmtamo-9Q aeafladalp�ie�tis�a['aSif�Vt�gf��daf�- �aP�oSt3nODad4yt6sde Bmtd+medalaa�pymfd,satieemotmy6efmwmNmdfu�e0ffiemeg- cf the t�l►ta•imdam aooeegp a�na. iiism�j rm3Q P�fl�litieL�epeamt�yatmmefs/aeaal �7ed�e.meeieg,..a..e..idc��..�6/reee.�e�nrbaib�e�ms�eioi - - CiLy arTown s -Ld (eadLM* L &CWromCkvk `Umd dim &"u*,NabVodw ��•5 ^ ��4; The Commonwealth of Massachusetts w" Department of Public Safety Massachusetts State Building Code (780 CMR) Building Permit Application to Construct, Repair, Renovate or Demolish any Building other than a One-or Two-Family Dwelling Code and Other Requirements for Building Permits The Department of Public Safety has issued these building permit application forms so that municipalities across the state can move toward use of a single permit form and consistent permit application process. The MA State Building Code specifies the requirements of building permits and the applicant is advised to review and be familiar with these requirements in order to avoid some of the common permit application problems.Likewise the applicant should be aware that some municipalities require that the owner confirm, even prior to acceptance of the building permit application, that no outstanding property taxes,water fees, etc. exist. Filing Instructions 1.Please contact the city or town where the work will be done to ensure that the city or town will accept this application form and if any additional information is required, and obtain the correct mailing address. After doing so, print the application, fill in completely and then submit to the local city or town where the work will be done. 2.All applications shall be considered complete and will be reviewed if construction documents, specifications, fee, and other materials that may be required as indicated in the Building Permit Application are included with the application. 3.Please include a check for the Building Permit fee. The fee maybe calculated using the information to be supplied in section 12 of the Building Permit Application. The check is to be made payable to the local city or town where the work will be done. b'dIt"Y 1-10LISe Corido AssociaLioti. 389 F sex Street Skon, MA 0 i97CI October 29, 2014 C t�, of Salem Insper6onal Scnrvices 120 I'Vashingto n St:, 3rd Irl»or Salern,:MA Ct 1970 C2car Sir: Scituate C`,asct rcrks rcce dy applied f6 a permit to conduct a ULCIICTI aCMIO(lCl of unit It - 3 at 389 Ls,ex Su cet,Salem, M':1.'C he avert iatloruaed that the need to iub,nut a leaer cerdlyiny aI)roval by the cun.d a .Sodmion of tt=e lWanned ienownion in unit # 3, ov nod by Christine.R&ill} IN runiodel tvill include the insrttlation of new cabinets, sink, cratntextop and dshwashen - IQ be une9crsigned rrusteefi of`the Kiley Hotise Coi,db�1ss�tciaif ott, approve, the planned kitchen renovadon in unit#f 3, Muck yomg ,1nt:iia t1 tllith unit# '- y 1 Xio _l; kau9'C�Itttl 111--) td, unit 2 � I J Christine Reilli; unit 3 RECEIVESERVICES EV The Commonwealth) assac usetts Department of Public1,,Sla1l1f ,, ooJ�Massachusetts State BuildinM9dCt�IARyA / Building Permit Application for any Building other than a One-or Two-Falhaily Dwelling (This Section For Official Use Only). lid Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block k and Lot N for locations for which a street address is not available) 39;? a�e7o -57 54,�nC& vsL No.and Street City/Town Zip Code Na e of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building,❑ Repair❑ Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other 'if Specify: RO 6 Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: � ON U / 5 / Ms z � SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA - Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-3❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ It: Residential R-10 R-2❑ R-3❑ Rd❑ S: Storage S-1 ❑ S-2❑ U: UtRity❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA Cl IIB ❑ IIIA ❑ IIIB ❑ 1 IV Cl I VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Water Supply: Flood Zone Information: Sewage Disposal: h Permit: Debris Removal: Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: niA t Ik[ n, Coiim,, n itr,ie, i rou±@: Not Applicable❑ is Structure within airport approach area? Is their review completed? or Consent to Build enclosed ❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICA'CE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain,ui Sprinkler System?: Special Stipulations: S ENT 7-0 751 � SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Pro eVty♦O+°nv,"ri i•i ^ ; D�{JL 6/rlak/v°rO0/9 ;K 'Name(Print) ,,�� No.and Street City/Town Zip Property Owner Conta tlnf nn5ti'on:8 I hAM gin A10-1 �LLs�u6 tr�J ��- ZSZ Y9Dl Title . Telephone No. (business) Telephone No. (cell) e-mail address If applichble, thc•prdperty,ownerhereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2). If building is less than 35,000 cu,ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction.Control - - ocal d�D.Fr4pe csloeg�� Nan (Registrant)- Telephone No. e-mailil adc�•41e V Registration Number Street Adr ress City T wn State Zip Discipline Exp' .tion Date 10.2 General Contractor- - .�,OrD Company Name Name of Per on Responsible for onstruction License No. nd The if Applicable Street Address City/T wn State Zip U aro/ g 2�3 77Y40 Telephone No. business Telephone No. cell e-mail address SECTION 11:1V0R1CFR5 C:Uhll'IiNSAIION'INSURANCE Al FIDAVI'1' M.G.C.c.152.§ 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 3. Plumbing $ 1. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other S Enclose check y�a able to P• 6.Total Cost 5 d, © (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Pl'rs• rint. nd sign name Title Telephone No. Date Yy et - 7- ��y "04 9 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: -"�•'0 Name Date CITY OF S,�L.E',i, ;ti�.15S:1CHUSETTS r ©CILDL\G DEP:1R-11ONT l?O CU.1S}'ILNGTou STREET, 1'0 FLOOa 'It..L (978) 745-9595 luacsERLEy oRlscou. F-jLX(978) 740-9844S Nbtyoa TrioacAS ST.PtE.RRs DmECCOR OF pusLIc pttOPERTy/8C1LDLNG COSOtISSIONER Construction Debris ,Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section it 1.5 Debris, and the provisions of bIGL c 40, S 54; Building Permit is is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by ,t IGL c 111, S 150A. The debris will be transported by: y (name ul-hauler) fhe debris will be disposed ot'in (name of tacaky) �� (address of facility) C sigoatur ufpn'mitapplicant date L C.UIVOO MY�2S s1C,N--o Co RAPID ROOFING GENERAL CONTRACTING CO. 22 MAY STREET. PEABODY, MASS. 01960 978-532-0181 / 978-740-0101 MASS LIC # 128253 / 144946/CS101965 WWW. GOPAPIDTODAY.COM RAPID ROOFING IS A DIVISION OF COYNE&SONS CONTRACTING COMPANY ARCHITECTURAL ROOFING ESTIMATE TO. 2/24/2014 PAUL ELLINGTON 389 ESSEX STREET. SALEM, MASS. 01970 617-686-9220 JOB SITE ADDRESS. SAME RE; ROOF ESTIMATE#2014-006 COMPLETE STRIP OF SLATE ROOFING TILES ON THE COMPLETE MAIN HOUSE ROOF OF THE PROPERTY. INSTALLATION OF 30 YR ARCHITECTURAL ASPHALT ROOFING SHINGLES AND CAP ON ENTIRE MAIN HOUSE ROOF OF THE PROPERTY.. 12 SQ.. WE AGREE TO. 1. COMPLETELY STRIP THE ENTIRE MAIN HOUSE ROOF OF THE PROPERTY, OF ALL THE EXISTING LAYERS OF SLATE SHINGLES ON THE ROOF OF THE BUILDING AT THE PRESENT TIME. 2. REMOVE ANY ROTTED ROOF DECKING BOARDS OR SHEATHING ON THE ROOFS OF THE BUILDING,AND INSTALL UP TO 100 FT.OF EITHIER ROOF BOARDS OR SHEATHING- FREE OF CHARGE (ONLY IF ROTTED AREAS ARE PRESENT). 3. INSTALL NEW WATER& ICE SHIELD ON THE COMPLETE TOP MAIN ROOF OF THE PROPERTY. 4. INSTALL NEW 15 LB. ASPHALT FELT ROOFING PAPER ON THE ENTIRE MAIN HOUSE ROOF OF THE PROPERTY.. 5. INSTALL NEW 8 INCH WHITE ALUMINUM DRIP EDGE ON THE ENTIRE MAIN HOUSE ROOF OF THE PROPERTY. 6. INSTALL ALL NEW VENT PIPE BOOTS ON THE MAIN ROOF OF THE a BUILDING AS NEEDED. tee., 7. INST L NEW ALUMINUM STEP FLASHING ON ALL AREAS OF THE O LETE JOB AS NEEDED. rw 8. INSTALL NEW 30 YR.. GAF TIMBERLINE ARCHITECTURAL ASPHALT ROOFING SHINGLES AND CAP ON THE ENTIRE OF THE PROPERTY; MAIN HOUSE ROOFS; 9 . NOTE ..REMOVE THE OLD EXISTING SKYLIGHT HATCH LOCATED ON THE MAIN ROOF OF THE BUILDING AND CLOSE IN THE EXISTING OPENING IN THE ROOF ONCE THE OLD SKYLIGHT HATCH HAS BEEN REMOVED FROM THE ROOF OF THE BUILDING. OPTIONAL.... COST OF$250.00 10. WE AGREE TO REMOVE ALL ROOFING DEBRIS FROM THE PROPERTY AND OBTAIN ALL BUILDING PERMITS AS REQUIRED BY LAW. 11. NOTE.. ALL NEW ROOF INSTALLATIONS HAVE A LIFETIME WARRANTY. ; BREAKDOWN OF COSTS ........ COMPLETE STRIP OF THE MAIN ROOF OF THE PROPERTY. r TOTAL COST OF JOB .................... .....$ 49200.00 WE HEREBY PROPOSE TO FURNISH ALL MATERIALS AND LABOR-COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS FOR THE SUM OF.... $ FOUR THOUSAND TWO HUNDRED DOLLARS-$ 4,200.00 WITH PAYMENTS TO BE MADE AS FOLLOWS.................... $2,100.00 DOLLARS DOWN/$2,100.00 TO BE PAID IN FULL UPON THE COMPLETION OF THE WORK.... I RESPECTFULLY SUBMITTED BY. RAPID ROOFING CONTRACTING COMPANY 22 MAY STREET. PEABODY, MASS. 01960 978-532-0181/978-740-0101/ 978-223-7740/ OWNER.. CHRISTOPIiER R. COYNE SR. NOTE-THIS PROPOSAL MAYBE WITHDRAWN BY US IF NOT ACCEPTED WITHIN-21 DAYS. ANY ALTERATION OR DEVIATION FROM THE ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS,WILL BE EXECUTED ONLY UPON WRITTEN ORDER, AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE. ALL AGREEMENTS ARE CONTINGENT UPON STRBCES,ACCRJENTS,OR DELAYS BEYOND OUR CONTROL. NOTE.1,AGREE THAT COYNE&SONS CONTRACTING COMPANY,OR ANY PARTIES HEREIN..ARE NOT LIABLE IN ANY WAY,AND CANNOT BE HELD LIABLE IN ANY WAY IN THE EVENT OF A ACT OF GOD OR NATURE.. WHICH INCLUDES STORM DAMAGE,WIND DAMAGE,WATER DAMAGE,FIRE DAMAGE,LIGHTNING DAMAGE, HURRICANES,ECT. WHILE WORKING ON ANY PROPERTY OR ANY PROJECT IN THE EVENT OF ANY SUCH DAMAGE SHOULD HAPPEN, AS STATED ABOVE. NOTE;ROOFING... WE CANNOT ACCEPT ANY RESPONSIBILITY FOR ANY DAMAGES.OR DEBRIS FALLING INTO ATTIC AREAS, CUSTOMERS SHOULD COVER VALUABLES,GREAT CARE WILL BE USED TO PROTECT THE EXTERIOR STRUCTURE BY COVERING THE EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENT ANY DAMAGES DURING THE STRIPPING OF THE ROOF,HOWEVER SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR CONTROL, HOMEOWNERS MUST MOVE ANY VALUABLES AWAY FROM THE BUILDING,PRIOR TO THE STRIPPING OF THE ROOF. NOTE; IF MORE LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE IN TH OWNER OF THE PROPERTY WILL BE IMMEDIATELY NOTIFIED,THE OWNER ACCEPTS ALL RESPO E ESTIMATE,THE NSIBILITY,AND (AGREES)THAT,ANY EXTRA CHARGES WILL BE ADDED FOR THE LABOR AND THE REMOVAL PO DEBRIS,OVER AND ABOVE THE PRICE OF THE ESTIMATE..,. OF THE EXTRA NOTE. IF FINAL PAYMENT HAS NOT BEEN RECEIVED OR PAID IN FULL AT THE TIME OF THE COMPLETION OF THE WORK, AS OUTLINED IN THE CONTRACT,AND RESULTS IN ANY TYPE OF COURT ACTION.. THE OWNER OF THE PROPERTY OR CONTRACTOR OF SAID JOB. OTHER THAN RAPID COMPANY... AGREES TO PAY ALL COURT FEES,ANY ATTORNEY FEES,AND INTEREST OF 12%COMPOUNDED EACH MONTH.,ON THE FINAL BALANCE OWED TO RAPID COMPANY ACCEPTANCE OF PROPOSAL THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENTS WILL BE MADE AS OUTLIN F D ABOVE.. DATE OF ACCEPT E SIGNATURE SIGNATURE SIGNATURE "'Z PLEASE MAKE ALL CHECKS PAYABLE TO CHRISTOPHER R. COYNE SR. THANK YOU!! 0 T Salem Historical Commission 120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction O Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 399 Essex Street Name of Record Owner: Kiley House Condo Association Tract Description of Work Proposed: Replace upper flat roof only. No work will be visible from the public way. Non-applicability due to the work not being visible from the public way. Dated: March 12, 2014 SALEM HISTORICAL COMMISSION By: 0�f The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. aCI'rY OF S.1=Nl, ANSSACHUSETITS BUILDING DEP.iR-rNnNT 120 W.,LsHNGTON STREET, 3'FLOOR TEL (978) 745-9595 F.A-x(978) 7.10-9846 KI\fBERI.F.Y DRISCOLL �'Y.iYOIt T1-tongs ST.P1FRRs DIRECTOR OF PUBLIC PROPERTY/BUILDNG CONLMISSION ER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informatinta �i r1 Please Print Legibly Name (13usincs Organiratiom'Inilividual):� //lam i/� �J�c�s �� Address: 9 Z G�l/�`r� ✓�T City/State/Zip: ell Phone Are an employer?Check the appropriate box: 'type of project(required): I. 1 am a employer with_ 3 4• ❑ I am a general contractor and I 6. ❑New construction eloployens(full and/or pan-time).' have hired the sub-contractors 2.❑ lama sole proprietor or partner- listed on the attached,hest.t 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working; for me in any capacity, workers'comp. insurance. y, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation mid its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plo repairs or additions myself. (No workers' cutup. C. 152, §](4),and we have no 12. oof repairs insurance required.] t employees. [No workers' comp. insurance required.] . l3.❑ Other •AnyappI caam slur checks but at must also('ill out the section W'owshowing theirwarkers'compensation policy inlinmation. 'I h�meawm"who what it this afndnvit indicating they arc doing all wok and then hire outside cantmctors mail suhmif a new afridaviI indicating such. $'ummctors thus Owl;this box most attachnf in additional shoot showing nw nano of the subaunlmcton and their workers'camp.pulicy infamtation. 1 ant on euployer that is providing workers'compensation insurance for my enopioyees. Bahoov Is the policy and fob site information. In.surancc Company Name: policy or Self-iris. Lic. 0;6A/PkO �C>7!F'�CJ _0 l Expiration Date: Wl�1 # __ �e:r�� y Job Site Address: / �>/ram—Y'� J t City/State/Zip:�W_;;50 / �f/� el"9Je Attach a copy of the workers'compensation policy declaration page(showing the policy number and zplration data). Failure to secure coverage as required under Section 25A of,VIGL c. 152 can lead to the imposition of criminal penalties of a line up to S1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.0.0 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of Investigations of the DI insurance coverage verification. I elo hereby ver .y and a perialtles uj eri. that floe hejornmNon provided above is true and correct S'D•n t iG Unto - �� Poe, : < F' C/ Official use only. Oo not write in this area, to be completed by city or town official City nr'fuwnt _.__.. . .__ Permiul.icense k Issuing Authority (circle One): 1. Board of licalth 2. Building Deparhnunt .1.Cityfrown Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Other Contact Person: _.. ___-- Phone M.:--_..._.